Hospitals, Policy

Does third-party neuromonitoring encourage healthcare fraud?

In an investigation published Sunday, The Austin (Texas) American-Statesman could find no specific case of someone being charged with fraud related to neuromonitoring, but payers and regulators are concerned.

Another front is forming in the endless battle between providers and payers: neuromonitoring. And regulators are looking into the possibility that some physicians are receiving kickbacks from firms that offer third-party monitoring services during brain and spine surgeries.

In an investigation published Sunday, The Austin (Texas) American-Statesman could find no specific case of someone being charged with fraud related to neuromonitoring, but a lot of people are asking questions as medical bills continue to rise.

The newspaper found that more than 40 different neuromonitoring companies registered in Texas all list the same business address in San Antonio, and some also are linked to the same address in Dallas. Most were set up in the last two years. The suspicion is that these monitoring providers set up affiliates through “complex business deals with surgeons,” according to the American-Statesman.

When told of the findings, Dr. George Lee, president of the Elmhurst, Illinois-based American Society of Neurophysiological Monitoring, said that he has known of such deals for several years and was concerned, but would not say if he has seen any illegal or unethical behavior. The partnerships “may constitute a kickback, but we are not in a position to investigate that,” Lee is quoted as saying.

Also concerned but lacking enough evidence to allege fraud is Aetna. Paul Weller, lead litigator in provider-related cases for the health insurer told the American-Statesman that “some of the medical necessity of the monitoring is in question,” but stopped short of calling the partnership fraudulent.

Likewise, Mari Robinson, executive director of the Texas Medical Board, which licenses and regulates physicians in the state, said that the board is investigating one complaint against an unnamed neuromonitoring company. However, Robinson said she was not aware of any disciplinary action against any Texas surgeons for holding a stake in such a company.

Texas requires physicians to disclose any financial interests they hold in facilities to which they refer patients.

Photo: Bigstock

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